Table Of ContentOXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Sport and Exercise
Medicine
Published and forthcoming Oxford Handbooks
Oxford Handbook of Midwifery 2e Oxford Handbook of Learning and
Edited by Janet Medforth, Susan Intellectual Disability Nursing
Battersby, Maggie Evans, Edited by Bob Gates and
Beverley Marsh, and Angela Walker Owen Barr
Oxford Handbook of Adult Nursing Oxford Handbook of Mental
Edited by George Castledine and Health Nursing
Ann Close Edited by Patrick Callaghan and
Helen Waldock
Oxford Handbook of Cancer
Nursing Oxford Handbook of
Edited by Mike Tadman and Musculoskeletal Nursing
Dave Roberts Edited by Susan Oliver
Oxford Handbook of Cardiac
Oxford Handbook of
Nursing
Neuroscience Nursing
Edited by Kate Johnson and
Edited by Sue Woodward and
Karen Rawlings-Anderson
Catheryne Waterhouse
Oxford Handbook of Children’s
Oxford Handbook of Nursing
and Young People’s Nursing
Older People
Edited by Edward Alan Glasper,
Edited by Beverley Tabernacle,
Gillian McEwing, and Jim Richardson
Marie Honey, and Annette Jinks
Oxford Handbook of Clinical
Skills for Children’s and Young Oxford Handbook of Orthopaedic
People’s Nursing and Trauma Nursing
Edited by Paula Dawson, Louise Rebecca Jester, Julie Santy, and
Cook, Laura-Jane Holliday, and Jean Rogers
Helen Reddy Oxford Handbook of Perioperative
Oxford Handbook of Clinical Skills Practice
in Adult Nursing Edited by Suzanne Hughes and
Edited by Jacqueline Randle, Frank Andy Mardell
Coffey, and Martyn Bradbury
Oxford Handbook of
Oxford Handbook of Critical Care Prescribing for Nurses and
Nursing Allied Health Professionals 2e
Sheila K Adam and Sue Osborne Edited by Sue Beckwith and
Penny Franklin
Oxford Handbook of Dental
Nursing Oxford Handbook of Primary Care
Edited by Elizabeth Boon, Rebecca and Community Nursing
Parr, Dayananda Samarawickrama, Edited by Vari Drennan and
and Kevin Seymour Claire Goodman
Oxford Handbook of Diabetes Oxford Handbook of Respiratory
Nursing Nursing
Edited by Lorraine Avery and Sue Edited by Terry Robinson and
Beckwith Jane Scullion
Oxford Handbook of Emergency O xford Handbook of Women's
Nursing Health Nursing
Edited by Robert Crouch, Alan Edited by Sunanda Gupta,
Charters, Mary Dawood, and Paula Debra Holloway, and Ali Kubba
Bennett
Oxford Handbook of
Gastrointestinal Nursing
Edited by Christine Norton, Julia
Williams, Claire Taylor, Annmarie
Nunwa, and Kathy Whayman
Oxford Handbook of
Sport and
Exercise
Medicine
Second edition
Edited by
Domhnall MacAuley
Specialist in Sport and Exercise Medicine and
visiting Professor at the University of Ulster.
Editor (Primary Care) at the BMJ
1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2013
The moral rights of the authors have been asserted
First Edition published in 2007
Second Edition published in 2013
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging in Publication Data
Library of Congress Control Number: 2012940770
ISBN 978–0–19–966015–5
Printed in China by
CC Offset Printing Co. Ltd
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
v
Contents
Foreword to fi rst edition vii
F oreword to second edition ix
Preface to fi rst edition xi
Acknowledgements xii
Contributors xiii
Symbols and Abbreviations xvii
1 Immediate care 1
2 Sports injury 35
3 Physiotherapy and rehabilitation 65
4 Benefi ts of exercise 95
5 Exercise physiology 123
6 Metabolic 171
7 Aids to performance 197
8 Disability 213
9 Arthritis 227
10 Cardiorespiratory 259
11 Infectious disease 311
12 Dermatology 323
13 Women 351
14 Older people 371
15 Head and face 383
16 Spine 423
17 Shoulder 455
18 Elbow and forearm 503
19 Wrist and hand 529
20 Abdomen 547
vi CONTENTS
21 Hip and pelvis 559
22 Knee 619
23 Ankle and lower leg 649
24 Foot 685
25 The team physician 711
I ndex 741
vii
Foreword to fi rst edition
The excellent authoritative Oxford Handbook of Sport and Exercise
Medicine is published at a singularly appropriate time. The Government
has just, belatedly many think, recognized an NHS Faculty of Sport and
Exercise Medicine. The new Faculty was launched at the Royal College of
Physicians by HRH Princess Royal, herself an Olympic equestrian medallist
now having a daughter with equal equestrian achievements.
It is fortunate that Professor Domhnall MacAuley has agreed to edit
this remarkable volume. To his credit he has been one of the leaders of
the campaign for the Faculty as well as advancing sports medicine practice
and teaching (and is now a Senior Editor with the B MJ ). He is to be
congratulated on this book, which although rather modestly described as a
handbook, is in fact a comprehensive encyclopaedia of sport and exercise
medicine. Its layout and indexing make it a quickly accessible practical
guide to all sports injuries both common and rare. It will be welcomed by
all sports medicine practitioners, both doctors and all the others in allied
professions like physiotherapy. It is a worthy successor to the O xford
Textbook of Sports Medicine , fi rst published by Oxford University Press in
1994 under the editorship of Mark Harries, then physician to the British
Olympic Medical Centre, with his colleagues Clyde Williams, William
Stanish, and Lyle Michaeli.
You may ask why offi cial recognition of sport and exercise medicine is
so important. The reason is that, by its very nature, sports medicine is a
polymorphous animal comprising an unusually large number of disparate
and loosely-linked subspecialties: respiratory and cardiac physiology and
medicine, physical medicine, physiotherapy, and orthopaedics to name but
a few. For the past 50 years it has not been possible to create an overall
umbrella body within which all can co-operate and work together. The
faculty will now do just this. Though the success of joining the pantheon
of 70 recognized specialties is a triumph in itself, it is only the beginning:
more NHS posts are needed, more skilled accident and emergency (A&E)
sports medicine trained staff. Also recognized is the inclusion of sports
medicine in qualifying and advanced examinations. A signifi cant victory
has been advanced, but many more battles lie ahead before sport and
exercise medicine fi nds a proper place in British medicine.
The government may have been persuaded that this was the right
moment for recognition with the realization that in 2012 some 10,000
athletes from around the globe will converge on London for the Olympic
Games. Britain can be a showcase for sports medicine as the sports men
and women will need and rightly expect the highest quality of care for
injuries they sustain, which inevitably occur when bodies are strained to
the limit and beyond. It should never be overlooked too that prompt and
effective treatment of sports injuries brings benefi ts to the health service
as a whole by encouraging better management of comparable traumatic
injuries in civilian life.
A further factor the government has recognized is that with average
television viewing of 9h a week for our children, coupled with bad diets, we
viii FOREWORD TO FIRST EDITION
face an obesity epidemic more serious than almost any country. The habit
of exercise must be gained in childhood. Exercise for exercise’s sake alone
rarely appeals to the young, but almost all will respond with enthusiasm
to some kind of sport well taught and supervised. This is badly neglected
in many schools, with playing fi elds sold off and sports teaching a minor
part of teacher training and curriculum time. Such a programme including
competitive sport needs alongside it a better sports injury service.
So, the future is bright for the Oxford Handbook of Sport and Exercise
Medicine and for sports medicine in Britain. The success of both is fully
deserved and I wish both well.
Sir Roger Bannister
October 2006
ix
Foreword to
second edition
This new edition of the Oxford Handbook of Sport and Exercise Medicine
refl ects the rapid development of the specialty in the last six years, since
Sport and Exercise Medicine (SEM) was recognized as a full specialty
within the National Health Service in Great Britain in 2005. Following four
years as a junior doctor there are now four years of specialist training in
the recognized SEM curriculum. With the creation of consultant special-
ists in SEM there is the opportunity to deliver an effective SEM service
within the NHS. This Handbook can be used in the clinic by specialists
and generalists; by team doctors preparing to care for their groups of
athletes or actually delivering that care on the touchline; by GPs seeing
anyone who cannot or should be exercising; and by other members of
the multidisciplinary team interested in any aspects of SEM. The format
of the Oxford Handbook enables concise yet comprehensive coverage of
the broad SEM curriculum from musculoskeletal injury, to cardiorespira-
tory illness, to infectious disease, to exercising with a disability, to doping
in sport. In daily practice, it is useful for anyone interested in the fi eld of
sport and exercise medicine to have a quick reference guide and also to
be confi dent that it is authoritative and accurate.
One of the reasons that SEM was recognized as a specialty was because
of the challenge of sedentary behaviour and lifestyles. Whether care of
athletes is delivered on the playing fi eld, in the changing room, in primary
care, or in an out-patient department, the main aim is to keep athletes and
patients exercising, get them back to their sport and exercise as quickly
as possible, and maintain fi tness while injured or ill. The ability to plan
rehabilitation with an accurate diagnosis and prognosis is hugely important
to success and adherence of anybody trying to stick to a long term exercise
and sport programme. The clear and well-presented information in this
Handbook will thus play an important part in keeping people active. There
are many factors needed to start individuals and athletes on their path
to an exercise habit and SEM will play an important part by empowering
clinicians to contribute to the onset as well as, crucially, the continuation
of exercise. Both athlete/patient and physician can approach the diagnosis,
rehabilitation, treatment, and graded return to exercise following
illness or injury with confi dence if they have an accurate diagnosis and
prognosis. Access to a book that is authoritative, clear, easy to reference,
and immediately to hand will make a real difference to this. The Olympic
and Paralympic Games in London in 2012 have been a catalyst for many
legacy initiatives and this new edition published in Olympic year can be
considered one of those legacies as a quality reference practitioners can
trust. Most users will not read the Handbook from cover to cover in one
sitting, but like any good reference or dictionary you will fi nd yourself
following trails and picking up interesting topics beyond what you were
initially looking for. I hope you will use this Handbook to improve your
